Patient Insight Discovered through Patient Experiences (PX)
1. Introduction
Patient centricity is a term that is often used to mean ‘focusing on the patient’. In recent years, ‘patient centricity activities’ have come to be proactively implemented as a part of trends aiming to develop medicinal products that are more focused on patients at pharmaceutical manufacturers in Europe and America. These patient centricity activities at the said pharmaceutical companies have been summarized in an easy-to-understand manner in “Medicine Development Utilizing Patient Opinions¹”, which is offered by Task Force 3 of the Clinical Evaluation Subcommittee of the Drug Evaluation Committee, Japan Pharmaceutical Manufacturers. The details are not discussed in this report.
We have been supporting communication with patients in relation to patient recruitment and patient research and we have received an increasing number of both domestic and foreign consultations regarding patient centricity activities. We have seen varying types of activities and issues that those companies are facing to; some corporations are already progressively moving forward with these activities while others are engaging in trials and errors or are still in a planning stage.
A recent development trend is for more drugs to be developed for rare or refractory diseases. This is making it even more necessary to understand patient status. In other industries, it is vital to have an understanding of general consumers, who use the products, when developing general products and establishing marketing strategies, where steady progress is being made. When developing new drugs and establishing marketing strategies for such drugs, industry customs related to industry standards and new initiatives tend to be conservative due to the high level of safety required. Therefore, a thorough understanding of patients, who are the consumers of medical care, has yet to be obtained.
Here, we will present basic content covering from general research methods to techniques, which is required for patient centricity activities, to elicit deeper patient insight and examples of utilization of such output.
2．Importance of Patient Insight
Patient insight refers to patients’ true intentions and what patients truly desire. In the general consumer goods and services industry, the term “consumer insight” is used. While marketing and strategic planning are also underway in the field of pharmaceuticals, they have mainly placed weight on the doctors and pharmacists prescribing the drugs rather than patients, who are the true consumers of medicine. If this is so, why is patient insight important?
When patients (medical consumers) need information related to health and medicine because they become aware of healthy lifestyle or suffer from poor health, various media including the internet offers information on medical treatment and care. Thus, medical consumers engage in various consideration and decision-making before visiting a medical institution. It is also possible that in clinical trials as well, which are one option when visiting a medical institution for treatment, incorporating patient opinions can make it easier to receive consent from patients, increase the number of enrollments and prevent dropouts².
Understanding the invisible perceptions and behavior of such patients (medical consumers) as insight is a process whereby useful information can be obtained. This information can then be used in the establishment of development strategies in Proof Of Concept (POC) and protocol design during drug creation and the development stages, or in planning marketing strategies directly before or after market launch.
3．Methods of Determining Patient Insight
While various methods may be used for research, the following risks are associated with “Listening & Asking”, which is a traditional method for determining patient insight.
-Risks of Traditional Research Methods (Asking)-
1. The consumer cannot explain their own purchasing behavior.
2. The consumer depends on the context (lifestyle situations).
(No context in questionnaires or group interviews)
3. People cannot necessarily express their own emotions and feelings in words.
4. It is difficult to explain the true reasons for things due to the unconsciousness and intuition.
5. Emotion is an important element of decision-making.
6. Memories change depending on how and when they are recalled.
(Responses to questionnaires and interviews could be created narratives)
A recent research method that can be used to avoid these risks is “Observation & Sensing”. For example, wearable sensor devices that can measure activity level and heart rate have become practical.
Research methods utilizing “Observation & Sensing” can be summarized as following³:
・Frameworks for gathering data in accordance with context
(Behavior observation, social listening, communities)
・Tools that captures timing of purchasing and motivation to purchase
(Mobile surveys, sensor tracking, communities)
・Technology to measure emotions and reactions without relying on words
(Brain wave measurement, heat mapping, facial expression analysis, genetic testing)
・Platform that enables natural behavior and natural consolidation
(Prediction markets, gamification, sensor apps)
(1) Analyzing patient opinions on social media (global usage rate: 52%⁴)
The number of users of SNS such as LINE, Twitter, Facebook and blogs exceeds 70 million people, accounting for 70% of internet users. Various consumer behaviors, experiences, ratings and evaluations can be seen as natural comments on SNS. Specific disease and drug names can be designated to collect comments with an analysis tool to analyze the texts. While the level of analysis differs depending on the number of comments that can be collected, qualitative and quantitative analysis can be performed to a sufficient level if data from the past year is gathered. It can catch various phenomena in a shorter time with low-cost than gathering subjects in a borrowed venue for a group interview.
(2) Patient insight surveys utilizing community (global usage rate: 59%⁴)
MROC stands for Marketing Research Online Community. It is a method to perform research by creating a specific online community globally that include not only general consumers but also professionals such as B2B and sales staff in various industries. While the comments of medical consumers and patients on social media cannot be controlled, creating a specific closed online community makes it possible to invite subjects to form populations with high interest in a specific theme. Findings can then be gathered through long-term dialogue, listening and observation.
With MROC, it is possible to gain deep insights through direct questioning and conversations such as questionnaires and interviews, or multifaceted viewpoints through behavioral observation of participant communities.
As subjects are not limited by distance if they have access to the internet, participation in surveys puts little burden on subjects of rare diseases for which it is difficult to gather subjects or diseases that causes difficulty moving.
If you are interested, please see “MROC of Women Troubled by Constipation” (https://www.croee.com/wp-content/uploads/2017/04/26.pdf [in Japanese]), in which an autonomous survey was conducted.
(3) What is a customer journey map (CJM)?
In 1980, “Moments of Truth”, authored by former CEO of Scandinavian Airlines Systems, Jan Carlzon garnered attention by individuals involved in marketing. This concept is based on the idea that 15 seconds of contact with customers can be the deciding factor in a company’s success or failure. While the idea of moments determining success or failure does not exist in Japan as such, it appears to be similar to the saying “Ichigo Ichie” (lit.: once-in-a-lifetime meeting), which originates in the art of tea ceremony and has long signified the importance of treating people with sincerity.
As the internet later spread, Google then proposed the Zero Moment of Truth (ZMOT) in 2010. This is a concept that prior to the First Moment of Truth (FMOT) proposed by P&G in 2004 describing the 3 – 7 seconds when consumers viewed products on store shelves, customers decide to buy a product before traveling to a store, by investigating product information online, looking at word-of-mouth on SNS or reading reviews on Amazon or similar sites.
These points related to purchase decision-making have been focused on in marketing up until this point. The process of customer to make an actions including purchase decision making, is called customer journey. A customer journey map visualizes various contact points with customers in the process leading to purchase decision-making, including previous consumption experiences, brand recognition, advertising communication and in-store promotions.
(4) What is patient experience (PX)?
This customer journey map concept can also be converted to the field of medicine. We will hereby introduce PX incorporating the essence of patient insight.
PX refers to “conscious and unconscious perceptions of medical consumers on the relationship between medical consumers and medical producers that is formed in the medical consumer life cycle as a result of all exchange by medical consumers with medical practitioners, medical devices and other medical service brands”.
To make it easier to understand, PX is patient experience covering all communication with medical practitioners and use of medication etc. from when the patient becomes aware of their illness and symptoms, gathers various information, selects and regularly visits a hospital, undergoes treatment by a physician, receive a prescription and takes medication and continues to face their disease.
Based on the concept of PX, a patient journey or a patient journey map visualize the entire flow of treatment from when the medical consumer first notices their illness and changes in physical symptoms, to when they investigate information on the disease and hospitals, purchase medication at a pharmacy and undergo examinations at a hospital. These are utilized in marketing strategy and communication design.
In the US, online advertising costs reached $77.37 billion in 2017, and it is forecast that online advertising costs will exceed television advertising costs (according to research by eMarketer). In Japan, online advertising costs reached 1.31 trillion yen in 2016, drawing close to the 1.9657 trillion yen being spent on television media-related advertising (according to research by Dentsu). As this growth in online advertising shows, both general and medical consumers are increasingly using the internet to gather information.
To grasp when patients (medical consumers) use the internet and how it affects decision-making etc., this concept of journeys (maps) can be used to visualize what contents are being accessed when on which devices (PCs, smartphones, or other devices). This information is useful for communication design and in strategy planning.
(5) Application to PX/PJM medical industry
Visualizing PX in a patient journey map can be utilized in various aspects of the medical industry. In the development stages, departments designing protocols, development departments actually involved in development operations and in the marketing stage, medical affairs department and marketing department members can use and share information on how patients first recognized their disease and symptoms and what information or who influenced a change in their attitude or behavior to match perceptions in shared materials.
In fact, as is shown in Figure 1, at one pharmaceutical manufacturer, patient-focused planning is being performed by having each of the development, affairs, product marketing, sales, PR, and advertising departments organize their meetings and workshops for strategic planning of PR, marketing, and sales, using patient journey maps and information on the patient populations of target diseases, and prepare briefing sheets for cooperating companies.
One method of utilizing patient journey maps is, as is shown in clinical trial advertising for uterine myoma in Figure 2, plotting what to convey via what media in the journey of uterine myoma patients undergoing follow-up observations. This makes it possible to design effective communication rather than unilaterally conveying information.
(URL: https://www.croee.com/wp-content/uploads/2017/08/170830_2.pdf)
We have hereby described some methods of applying patient image visualization through PX.
In general marketing, STP strategy is utilized with the following as a framework:
・Market segmentation (Segmentation)
・Target demographic identification (Targeting)
・Establishing competitive superiority for target demographics (Positioning)
When doing this, it is necessary to understand customer images (patient images) and to share information between the stakeholders.
“Development of Medicine reflecting Patient Opinions¹”, which is offered by Task Force 3 of the Clinical Evaluation Subcommittee of the Drug Evaluation Committee, Japan Pharmaceutical Manufacturers, also contains the following comment: “The expected effect of reflecting direct opinions or real experience of patients who are the ultimate customers for pharmaceuticals in development of medicines is to provide medicines valuable to patients at an early stage. It is hoped that this will benefit not only patients but also pharmaceutical companies.”
PX collected based on patient centricity, could be widely utilized in medicinal product development from the early stages until after market launch. We hope that this report will form a valuable reference on effective practical implementation of this concept for all those involved in pharmaceutical development and product strategy.
■References
1) Japan Pharmaceutical Manufacturers Association, “Pharmaceutical Development reflecting Patient Opinions – Patient Centricity by Pharmaceutical Companies” 2018.6
http://www.jpma.or.jp/medicine/shinyaku/tiken/allotment/patient_centricity.html
2) Levitan B, Getz K, Einstein E L, Goldberg M, Harker M, Hesterlee S, et al. Assessing the Financial Value of Patient Engagement; A Quantitative Approach from CTTI’s Patient Groups and Clinical Trials Project. Therapeutic Innovation & Regulatory Science 2018;52(2):220-9
3) Wendy Gordon, Behavioral economics and qualitative International Journal of Market Research Vol.53 Issue 2(2010)
4) GRIT (GREENBOOK RESEARCH INDUSTRY TRENDS REPORT)
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●Translated from Japanese article written by Mr. Toru Sugimoto (Group Director of Marketing Service Group, CROèe.Inc.)
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